Pleural Effusions

A total of 80 mL or more of pleural fluid (i.e., > 40 mL in each pleural cavity) is found in nondrowning cases (e.g., intoxication, strangulation, smothering, stabbing 138 ). The origin of the pleural fluid could result from disease, if the autopsy reveals underlying cardiac abnormality (e.g., myocardial hypertrophy or scarring 138 ). A combined weight of the lungs and pleural effusions between 1000 and 2200 g was observed in more than three-fourths of cases having a submersion interval of...

Other Scene Findings and Background Information in Suicide

If self-inflicted wounds are not immediately lethal, then blood can be shed at various sites, indicating purposeful activity prior to death (Fig. 3 refs. 16, 22, 105, and 109). The deceased's footprints can be evident in bloodstains (60). Fig. 2. Suicidal gunshot wound of head. Abrasion (arrow) on leg where breech of rifle contacted the leg steadying the weapon. Fig. 2. Suicidal gunshot wound of head. Abrasion (arrow) on leg where breech of rifle contacted the leg steadying the weapon. A...

Decubitus Ulcers Pressure Sores

Pressure on skin overlying bony prominences (e.g., spine including sacrum, scapulae, elbows, greater trochanters, heels, and ankles) can result in decubitus ulcers (69-75). Fig. 24. Bite mark on back. Dental impression on mold. Fig. 24. Bite mark on back. Dental impression on mold. Decubiti occur in patients in nursing homes and hospitals or at home (73,76). Prevalence of ulcers in these patients was about 11 in one series (73). One prospective postmortem study showed a similar frequency (72)....

Distribution and Pressure Points

Compressed parts of the body result in areas of normal-colored skin demarcated by lividity. If a deceased individual is supine, pressure points are observed on the occipital scalp, midback, buttocks, posterior thighs, calves, and heels (Fig. 10). If prone, pressure is applied to the forehead, nose, cheek (if the head is turned), chin, chest, lower abdomen, and anterior thighs. Pressure points also develop in areas of constriction or Fig. 10. Person found dead in supine position. Livor on back....

Degree and Direction of Force and Cause of Death

Generally, multiple, extensive, and open cutaneous injuries imply a greater degree of force. Injuries distributed on different surfaces of the body may, depending on the circumstances of injury, represent multiple concurrent impacts or repetitive trauma. A cutaneous injury is an external sign of severe visceral injury and indicates significant absorption of energy at that site. Rarely, fatal exsanguination is caused by a skin laceration (Fig. 7). Extensive soft tissue trauma can be a cause of...

Therapeutic Misadventure

A fatality caused by a therapeutic misadventure is defined as a death that arises from an unexpected medical care-related injury or adverse outcome during or immediately following a medical procedure or treatment and that is not a consequence of an inherent disability or prior medical condition, side effect, or natural complication of the involved procedure or medication (160). Therapeutic misadventure includes mechanical manipulation for diagnosis or treatment incorrect, mistaken, or...

Injury Pattern Patterned Injury

Many wounds caused by blunt trauma are nonspecific in determining the nature of the blunt surface that caused those injuries. An injury pattern is defined as a predictable but nonspecific injury having a characteristic distribution consistent with a particular traumatic event (Fig. 13). Blunt trauma injury patterns are seen in certain types of deaths. Chronic alcoholics, when intoxicated, fall repeatedly. They are predisposed to bleeding because of abnormal coagulation caused by cirrhosis (Fig....

Children and Adolescents 2151 Suicides

Suicide by hanging is rare in children. An Australian study observed that 3.7 of 298 hanging deaths occurred in children 12 yr of age or younger (28). An 8-yr-old male victim was documented in an American study (15). Another study noted a 9-yr-old boy (102). A 7-yr-old was observed in a series from Northern Ireland (50). Scottish and Turkish series showed a minimum age of 11 yr and a male predominance (103,104). Various reasons for children committing suicide include anger toward parents,...

Anaphylaxis Insect Bites and Injections

Anaphylaxis (anaphylactic shock) is an immediate type of hypersensitivity reaction leading to peripheral circulatory collapse (152). Anaphylaxis is estimated to cause about 500 deaths annually in the United States (153). Anaphylaxis is triggered by the release of histamine and other inflammatory mediators from tissue mast cells (152). Activation of mast cells is the result of interaction of an allergen and a specific IgE antibody on the mast cells, but certain drugs and diagnostic agents also...

Injury From Smoke Inhalation

Smoke interferes with normal airway clearance by respiratory epithelium, causes bronchospasm, and affects surfactant-producing pneumocytes (104,108,112). Inhalation Systemic Complications Post-Burn Significant in the Determination of the Cause of Death Neurological complications from carbon monoxide (CO) poisoning hypoxic-ischemic encephalopathy (100). Inhalation injury (smoke, toxic agents, hot gas, e.g., steam) (94,98,100,102,103). Acute laryngeal edema. Eventual necrotizing or...

Abdominal Compartment Syndrome

The normal pressure of the peritoneal cavity is at most atmospheric and varies inversely with intrathoracic pressure during respiration (398). Intra-abdominal pressure (IAP) is elevated when any type of severe abdominal trauma is associated with massive fluid resuscitation, hemoperitoneum, bowel edema, attempted surgical closure of a non-compliant abdominal wall, and use of intra-abdominal packing. Circumferential burn eschar causes extrinsic compression (see Chapter 4, Subheading 5.2.)....

Internal Injuries Owing to Electrocution Table

Hand Grenade Damage

Hospitalized electrocution victims can show evidence of myocardial ischemia and arrhythmias 139,141,145,147,149,152,158 . Because of the onset of arrhythmia can be delayed, these patients are monitored for 24 h after admission, particularly when there is a history of heart disease, loss of consciousness at the scene, or apparent current flow through the heart 139,141,142,145,232,233 . The heart can be normal at autopsy 181 . Petechiae may be found in the myocardium, and larger hemorrhages have...

Electrical Burns and Other External Trauma

Low Voltage Electrical Exit Burns

Direct contact is the most common mechanism of injury 158 . The greater the skin resistance, the more likely that burns will result 141 . A smaller surface area of Fig. 31. Electrocution burns contact or entry site . A Worker's glove. B Burn on hands. Courtesy of Dr. D. King, Regional Forensic Pathology Unit, Hamilton, Ontario, Canada. contact means a greater current intensity and severity of injury 158,163 . Skin burns can be absent even in high-voltage electrocutions, if the contact area is...

External Examination of a Submerged Body

Drowning Froth

Froth meringue-like is expressed around the mouth and nostrils in a typical wet drowning see Headings 10. and 12. Fig. 3 and refs. 6 and 16 . Froth can be washed away by the action of water before body retrieval, disappear after the body has been in the open, or removed before transfer of the body for autopsy 3 . Froth may be not seen by investigators at the scene 3 . In one study, external foam was observed in only 19 of cases 3 . Fig. 3. Wet drowning. Froth from nose and mouth. Fig. 3. Wet...

Circumstances of Fire

Flame injury is the most common type of burn faced by a pathologist 1-3 . All manners of death are possible. Determination of the cause and manner of death requires integration of scene findings and other information provided by fire investigators and police with postmortem findings and ancillary toxicological and chemical testing 4 . Residential fires accounted for three-fourths of fire deaths in a North Carolina study 5 . Two-thirds of the victims were male, and almost half were home alone....

Pharyngeal and Gastric Contents

Terminal aspiration of sterile acidic gastric contents and oropharyngeal secretions containing bacteria occurs frequently as an agonal event and is often observed at autopsy 395 . Cough and gag reflexes are depressed at death, allowing agonal regurgitation into the airway 396 . This is not necessarily a cause of death, but a sign that an individual is obtunded 36,209,333,396 . Psychiatric and neurological disorders that lead to choking cause aspiration of vomit 397 . Aspiration of gastric...

Livor Mortis Livor Lividity Postmortem Hypostasis Postmortem Suggilation

Lividity Rigor Mortis

Because of the cessation of blood flow at death, there is gravitational settling of blood that distends capillaries and veins, resulting in discoloration of skin in the non-compressed dependent areas of the body Fig. 9 . Slight hypostasis has been described in living individuals dying from a prolonged illness and terminal circulatory failure 4 . Patchy lividity 1- to 3-cm or about 0.5- to 1-in. areas has been described in nonde-pendent areas of the body and attributed to venous blood being...

Info

B., Schmeckpeper, K., Strope, M. Jail suicides by hanging. An epidemiological review and recommendations for prevention. Am. J. Forensic Med. Pathol. 8 27-31, 1987. 87. Copeland, A. R. Fatal suicidal hangings among prisoners in jail. Med. Sci. Law 29 341-345, 1989. 88. He, X. Y., Felthous, A. R., Holzer, C. E., III, Nathan, P., Veasey, S. Factors in prison suicide one year study in Texas. J. Forensic Sci. 46 896-901, 2001. 89. Topp, D. O. Suicide in prison. Br. J. Psychiatry 134...

Chest Compression and Cephalic Petechiae

The jugular venous system divides into the more superficial external jugular vein EJV and the internal jugular vein IJV . Not all veins of the head and neck are valve-less. The IJV valve is situated 0.5 to 2 cm up to 0.75 in. above the union of the subclavian and internal jugular veins 30 . The valve normally prevents retrograde blood flow to the brain when there is increased intrathoracic pressure e.g., coughing 30 . In individuals with a normal central venous pressure CVP , coughing creates...

Plastic Bag Asphyxia

Bag Asphyxia

Plastic bag asphyxia results from decreased oxygen concentration in the available inspired air and physical obstruction of the mouth and nose 257 . The latter mechanism arises when a plastic bag becomes electrically charged and adheres to the face, aided by Fig. 51. Plastic bag asphyxia suicides . knotting and tying of three plastic bags. Fig. 51. Plastic bag asphyxia suicides . knotting and tying of three plastic bags. A Elderly woman. B Neck pallor created by condensation 242,257 ....

Postmortem Hemorrhage

Forensic Pathology

Bleeding occurs after death if blood vessels, engorged by blood postmortem, rupture. Contributory factors include increased pressure caused by body position, early decomposition, and trauma. Rupture of capillaries is manifest as petechiae Tardieu spots . The development of petechiae is a harbinger of decomposition, but they can be seen as early as 2 to 4 h after death, if the body has been suspended 6 . Rupture of larger vessels venules causes purpura or larger ecchymoses. The distribution of...

Hanging

Hanging Forensic Pathology

Hanging is defined as a constriction of the neck because of force applied as a result of suspension by the weight of at least part of the body Fig. 3 refs. 3 and 43 . The typical hanging death involves tightening of a ligature, but this is not necessary 29,44 . Accidental hanging may not involve a ligature see Subheading 2.1.5. and ref. 28 . Although hanging is a form of ligature strangulation, the latter implies neck constriction from a ligature not tightened by the body's weight during...

Scene and Circumstances Accidental Choking Deaths The phases of acute fatal airway obstruction are

Penetration of the object into the airway. 3. Failure to expel once the obstruction has occurred 333 . Witnesses of a sudden death may describe signs of acute upper airway glottic obstruction stridor, respiratory distress, coughing, choking and the inability of the victim to speak 334-337 . A rapid, deep inhalation frequently follows, causing a foreign object to pass further down the airway 333,338 . Laryngospasm occurs 338 . At this point, vagal stimulation, leading to arrhythmia and apnea,...

Variants of Decomposition

Mummification Pathology

Drying mummification is a variant of decomposition. Localized drying can affect the tip of the partly exposed tongue, the lips, the tips of fingers and toes, and the scrotum Figs. 32-34 . If the eyelids are not closed after death, then scleral drying appears as a horizontal brown line taches noires scl rotiques see Fig. 35 . Another eye change is corneal clouding. It occurs 2 to 3 h after death if the eyes are open, and by 24 h if they are shut 6,8 . Generalized transformation of skin to a...